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Impact of rotavirus vaccines in low and middle-income countries

Sindhu, Kulandaipalayam Natarajan Chella; Babji, Sudhir; Ganesan, Santhosh Kumar

Current Opinion in Infectious Diseases: October 2017 - Volume 30 - Issue 5 - p 473–481
doi: 10.1097/QCO.0000000000000397
GASTROINTESTINAL INFECTIONS: Edited by A. Clinton White and Gagandeep Kang
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Purpose of review Rotavirus vaccines are playing a pivotal role in improving lives of infants and young children in low and middle-income countries (LMICs). Many of these countries have adopted the vaccine into their routine immunization, whereas others are considering introduction. This article provides an update on the impact of rotavirus vaccines in LMICs on morbidity and mortality in children aged less than 5 years, and their cost-effectiveness.

Recent findings The WHO, in 2013, updated its recommendation to prioritize introduction of rotavirus vaccines in the routine immunization schedule, without age restrictions. Despite the decreased efficacy of the vaccines in LMICs, data from Sub-Saharan Africa have demonstrated a decrease in rotavirus-related morbidity, with some sites reporting an indirect protective effect on children age ineligible to receive the vaccine. Even with improvements in sanitation, nutritional status in children, and other health-related indices in LMICs, the use of rotavirus vaccines will play an important role in preventing rotavirus-related gastroenteritis. Economic models predict a reduction in economic burden because of rotavirus-related health costs, making vaccine introduction cost-effective in resource-constrained settings.

Summary Increasing evidence from impact studies shows the significant impact of rotavirus vaccination on hospitalizations and economic burden because of rotavirus gastroenteritis in LMICs. Universal rotavirus vaccination is recommended, and introductions should be monitored by robust surveillance systems to measure effectiveness and impact.

Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence to Sudhir Babji, MD, Division of Gastrointestinal Sciences, Christian Medcial College, Vellore, Tamil Nadu 632004, India. Tel: +91 416 228 2052; fax: +91 416 228 2486; e-mail: sudhirbabji@cmcvellore.ac.in

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